11 September 2007

BUFFALO, N.Y. (AP) -- Kevin Everett voluntarily moved his arms and legs on Tuesday when partially awakened, prompting a neurosurgeon to say the Buffalo Bills' tight end would walk again -- contrary to the grim prognosis given a day before. [...]

Everett's agent, Brian Overstreet, also said Everett's mother told him the player moved his arms and legs when awakened from a deeply sedated sleep.

"I don't know if I would call it a miracle. I would call it a spectacular example of what people can do," Green said. "To me, it's like putting the first man on the moon or splitting the atom. We've shown that if the right treatment is given to people who have a catastrophic injury that they could walk away from it."

Green said the key was the quick action taken by Cappuccino to run an ice-cold saline solution through Everett's system that put the player in a hypothermic state. Doctors at the Miami Project have demonstrated in their laboratories that such action significantly decreases the damage to the spinal cord due to swelling and movement.

"We've been doing a protocol on humans and having similar experiences for many months now," Green said. "But this is the first time I'm aware of that the doctor was with the patient when he was injured and the hypothermia was started within minutes of the injury. We know the earlier it's started, the better."

I am truly happy for Kevin Everett, in that what appeared to be a catastrophic injury may yet yield the possibility for significant functional recovery -- though it is yet much too early to say.This is, however, the first I have heard of this particular therapy. It is really no surprise. At out facility we have been performing therapeutic hypothermia for post cardiac arrest patients for a while now, and this is functionally the same thing.

The concept is simple: Neurons have a voracious appetite for oxygen, and when deprived of it, very quickly begin to undergo cell death. So, the theory goes, by dropping the body temperature very rapidly as quickly as possible after an anoxic insult to neural tissue, as the brain is deprived of oxygen during cardiac arrest, you can slow the metabolic rate and greatly reduce the magnitude of cellular damage. And since it is pretty clear that spinal cord injuries (SCI) have a fundamental mechanism of cord contusion/edema/anoxia as the actual mechanism of injury, it makes sense that this application might be beneficial for SCI.

We'll see if it's the real deal. And there's obviously a huge time-sensitive factor here, like for strokes, since neuron death occurs quickly. But it seems to this jaded eye that this is the first treatment for SCI that has actual promise. I look forward to seeing some real studies on this.

So can we stop wasting ten grams of Solu-medrol on all our SCI patients now?

This is indeed great news. I am a scientist at the Miami Project and for many years we have been using the moderate hypothermia protocol on rats. The results, however, improved significantly with the concurrent application of methylprednisolone. This is of course, not to say that moderate hypothermia does not provide significant neuroprotection, it does. Combination with Solu-Medrol has shown to increase white matter sparing and improve functional recovery in the contusion model. It will be really interesting to see a published clinical trial on the subject, but as we know, human subjects are extremely difficult to obtain. For know we will stick to rats and hope for the best!

I was under the impression that the partial hypothermia was induced to reduce swelling around the spinal cord, and not primarily to combat anoxic pressure. That was indeed the thrust of the main article I read on the subject.

Thank you , anonymous. I am pleased to know the rats are doing well. Have the rat studies been published? Must I now watch ESPN for my medical news? The media is doing their overhyped premature sensationalist reporting , putting clinical docs into delicate situations.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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